Methods to enhance a non-surgical medical treatment

ABSTRACT

In an embodiment, a method to enhance a non-surgical medical treatment, the method including applying a composition having an antifibrinolytic agent to an area of skin for non-surgical medical treatment, where the applying is at least one of before, during, and after the non-surgical medical treatment, beginning the non-surgical medical treatment to the area of skin, and continuing the non-surgical medical treatment until the non-surgical medical treatment is completed. In some embodiments, the antifibrinolytic agent is tranexamic acid in an amount of about 20% (w/v). In some embodiments, the method further includes minimizing, by the antifibrinolytic agent, bruising caused by the non-surgical medical treatment. In an additional embodiment, the present disclosure relates to a composition to enhance a non-surgical medical treatment, the composition having an antifibrinolytic agent. In a further embodiment, the present disclosure relates to a kit having a carrier and an antifibrinolytic agent.

CROSS-REFERENCE TO RELATED APPLICATIONS

This patent application is a continuation-in-part of PCT/US2018/026086,filed on Apr. 4, 2018. PCT/US2018/026086 claims priority from, andincorporates by reference the entire disclosure of, U.S. ProvisionalApplication No. 62/481,162 filed on Apr. 4, 2017.

TECHNICAL FIELD

The present disclosure relates generally to a non-surgical medicaltreatment and more particularly, but not by way of limitation, methodsand compositions to enhance a non-surgical medical treatment.

BACKGROUND

In the course of non-surgical medical treatments, such as thoseassociated with cosmetic or dermatology procedures, patients can besubject to unwanted swelling, inflammation and/or bruising that isassociated with a treatment, for example, the injection of fillers orneurotoxins, or the application of chemical peels, acne treatments,dermabrasion techniques and laser skin treatments. With respect toinjection-type treatments, the needle and pressure can cause slightbleeding, and to counter this activity, certain vasoconstriction agents,such as epinephrine, can be applied to the tissue to reduce the size ofblood vessels prior to injection, thereby making it less likely to beinjured during a treatment, as well as reduce the amount of bleeding dueto the size of the constricted blood vessel. However, vasoconstrictionagents, such as epinephrine, can have a “rebound effect” which cancreate unwanted effects as the drug wears off and the vessels return totheir normal state.

SUMMARY OF THE INVENTION

In an embodiment, a method to enhance a non-surgical medical treatment,the method including applying a composition having an antifibrinolyticagent to an area of skin for non-surgical medical treatment, where theapplying is at least one of before, during, and after the non-surgicalmedical treatment, beginning the non-surgical medical treatment to thearea of skin, and continuing the non-surgical medical treatment untilthe non-surgical medical treatment is completed.

In another embodiment, a method to enhance a non-surgical medicaltreatment, the method including applying a composition having anantifibrinolytic agent to an area of skin for non-surgical medicaltreatment, where the applying is at least one of before, during, andafter the non-surgical medical treatment, and where the antifibrinolyticagent includes tranexamic acid in an amount of about 20% (w/v),beginning the non-surgical medical treatment to the area of skin,continuing the non-surgical medical treatment until the non-surgicalmedical treatment is completed, and minimizing, by the antifibrinolyticagent, bruising caused by the non-surgical medical treatment.

In an additional embodiment, the present disclosure relates to acomposition to enhance a non-surgical medical treatment, the compositionincluding an antifibrinolytic agent.

In a further embodiment, the present disclosure relates to a kit havinga carrier and an antifibrinolytic agent.

DETAILED DESCRIPTION

In various embodiments, methods and compositions are used to enhancenon-surgical medical treatments that are susceptible to bruising,swelling, inflammation or similar occurrences, the method includesapplying an antifibrinolytic agent to an area of the skin within whichthe non-surgical medical treatment is performed, with the agent beingapplied prior to, during and/or following the non-surgical medicaltreatment. In certain embodiments, there are a number of additionalnon-surgical cosmetic and dermatological treatments that involvebruising, swelling and inflammation, such as chemical peels,dermabrasion, acne treatments and laser skin treatments.

In a professional survey of 100 plastic surgeons, dermatologists, andother practitioners performing a high volume of dermal fillerprocedures, over thirty-eight per week, 65% of the survey participantsresponded that they would routinely use a product in dermal fillerprocedures that reduces bruising by 50 to 60%. In addition, many of theparticipants responded that they would use such a product in a varietyof other non-surgical procedures, such as, but not limited to, laserskin resurfacing (81%), chemical peels (49%), pulsed light treatment(41%), microdermabrasion (38%), laser hair removal (30%), acnetreatments, tattoo removal, and the like. As such, there is a need formethods and compositions to reduce and/or eliminate bruising in patientsundergoing non-surgical medical treatments.

Various embodiments of the present invention will now be described morefully with reference to the accompanying tables. The invention may,however, be embodied in many different forms and should not be construedas limited to the embodiments set forth herein.

An object of the present invention is to provide methods andcompositions to minimize or reduce swelling, inflammation, bruising, orcombinations of same and the like, resulting from a non-surgicaltreatment which can thereby enhance the non-surgical treatment. Afurther object of the present invention is to enhance a non-surgicalmedical treatment using dermal fillers and toxins by extending theduration/function of the non-surgical medical treatment. In certainembodiments, the present invention can be utilized with a number ofnon-surgical cosmetic and dermatological treatments that involvebruising, swelling and inflammation, such as chemical peels,dermabrasion, acne treatments and laser skin treatments. As used herein,a non-surgical medical treatment can involve various treatments,including, but not limited to, cosmetic or dermatologic procedures toimprove physical appearance for aesthetic reasons, treatments to repairthe effects of injury, disease or malfunctions, including medicines,physical and radiation therapies, and are typically non-invasive innature, for example, a medical treatment with no linear incisions of theskin. In some embodiments, the cosmetic or dermatologic procedures caninclude, without limitation, dermal filler procedures, neuromodulatorinjections, laser skin resurfacing, chemical peels, pulsed lighttreatments, microdermabrasion, laser hair removal, acne treatments,tattoo removal procedures, or combinations of the same and like.

In accordance with the present invention, the non-surgical medicaltreatment is enhanced by the administration of an antifibrinolyticagent, or agents, before, during and/or after the non-surgical medicaltreatment of a human patient. As used herein, the term “enhance” meansminimizing or reducing swelling, inflammation, bruising or combinationsof same and the like, and may also involve extending theduration/function of dermal fillers and toxins. A practice of thepresent invention could be to utilize an antifibrinolytic agent, oragents, prior to a non-surgical treatment to provide for less swelling,inflammation and/or bruising, while further providing rapid andeffective healing, for example, by limiting fibrinolytic activity, suchas the conversion of plasminogen to plasmin, in or around the treatmentarea to thereby enhance the non-surgical medical treatment.

An antifibrinolytic agent can be provided to mitigate swelling,inflammation, bruising, or combinations of same and the like, that maybe associated with a non-surgical medical treatment, such as, injectionsand/or applications of therapeutic, cosmetic, or dermatologictreatments. The antifibrinolytic agent may be a simple aqueous solution,or it may be combined with a pharmaceutically acceptable carrier, forexample, gels, lotions, ointments, or creams, and may optionally containother active or inactive treatment ingredients and/or preservatives. Insome embodiments, the gels can be a gel or gel-like material. In someembodiments, the gel can include, without limitation, xanthan gum,hydroxyethylcellulose, or combinations thereof. In some embodiments, ahydroxyethylcellulose formulation can improve shelf-life stability anduser-friendliness. In some embodiments, the antifibrinolytic agent canbe combined with, for example, excipients to alter pH, excipients toprovide stability, various preservatives, excipients for coloring, orother excipients for varying uses known to those of ordinary skill inthe art. The solution and/or compound can be administered directly on,or into, the skin days, hours or minutes prior to the injection orapplication of a non-surgical medical treatment, during the treatmentand/or following the treatment to minimize swelling, inflammation and/orbruising subsequent to the treatment. In some embodiments, theantifibrinolytic agent solution and/or compound can be pre-soaked on,for example, towelettes or gauze, for use when applying theantifibrinolytic agent before, during, and/or after a non-surgicalmedical treatment. In some embodiments, a towelette pre-soaked withtranexamic acid is utilized for application of the composition to theskin. In some embodiments, pre-soaked gauze is utilized for applicationof the composition to the skin. The antifibrinolytic agent may also bedelivered systemically to provide similar cosmetic and/or healingbenefits in non-surgical medical procedures. In certain embodiments, acombination of topical and systemic administration may be used.

For intravenous administration of one common antifibrinolytic agent,tranexamic acid (TA), the minimum dosage for the agent is about 10 mg/kgbody weight. A more common dosage is about 10 mg/kg body weight prior totreatment, and 1 mg/kg/hour for 12 hours thereafter if continuousinfusion is used. If a continuous infusion is not used, a second bolusof 10 mg/kg either at the end of treatment or after about 8 hoursfollowing the initial dose, is administered. The maximum dose is about80 mg/kg in total amount given during the course of the treatment. Thedose should be administered about 10-30 minutes prior to the start oftreatment. With respect to trauma events, dosings should be administeredwithin 3 hours following the event.

For oral administration, about half of the TA ingested does not enterthe blood, so the minimum and maximum doses would be twice the amountfor IV administration. For indications like heavy menstrual bleeding,repeat administration should occur about every 8 hours for up to 5 days.Dosages for another common antifibrinolytic agent, epsilon-aminocaproicacid, are approximately ten times the dosage for tranexamic acid.

For the purpose of the present invention, the antifibrinolytic agent canact prophylactically, due to its continued activity in the tissue, toprepare and protect the treatment area for subsequent non-surgicalmedical treatments, as well as to facilitate a rapid and improvedhealing process after non-surgical medical treatments. The agent couldbe applied and composed in such a manner that it would not negativelyaffect the treatment and/or injection materials. In various embodiments,the agent can be delivered subsequent to an injection, for example, tocontinue the therapy throughout the post-procedure period where delayedbruising, inflammation and/or swelling might occur, for example, over 2to 7 days.

The present invention can be practiced where the antifibrinolytic agentis administered after the non-surgical medical treatment has started,without prior administration of the antifibrinolytic agent. In suchpractice, the agent would be administered during and/or after thenon-surgical medical treatment. When administered after the non-surgicalmedical treatment, such administration should be promptly done, such aswithin one hour, for example, after the non-surgical medical treatmentis completed. Further, the present invention could be practiced bycombining the antifibrinolytic agent with the treatment materials beinginjected. For example, tranexamic acid and hyaluronic acid could becombined to form the injected materials, with or without a prioradministration of an antifibrinolytic agent. In some embodiments, theantifibrinolytic agent can be combined with, for example, a cross-linkedhyaluronic acid polymer, sodium hyaluronate, dermal fillers,neurotoxins, hyaluronic acid, or combinations thereof. In someembodiments, the antifibrinolytic agent can be aprotinin, tranexamicacid, epsilon-aminocaproic acid (EACA), Kunitz domain (KD1) inhibitor,AZD 6564, mimetics, and analogues or derivatives of the same. In someembodiments, the antifibrinolytic agent can be a mimetic, an analogue,or derivative of tranexamic acid.

Antifibrinolytic agents have been shown to improve the hemostasisprocess during surgery due to the ability of the agent to reduce clotlysis, or breakdown. Antifibrinolytic agents have also been shown to beeffective at reducing bleeding and transfusions in patients withhemophilia who undergo dental extractions. In addition, antifibrinolyticagents have been shown to reduce heavy menstrual bleeding whenadministered orally.

The present invention utilizes the activity of the antifibrinolyticagent prior to, during and/or optionally post-treatment, in order toavoid or reduce unwanted bruising, inflammation and/or swelling innon-surgical procedures. The present invention recognizes that theactivity of the agent to reduce inflammation, bruising, and/or swellingis not necessarily solely an antifibrinolytic function or solely relatedto a reduction in bleeding, but can further involve a protective andhealing effect by improving the tissue environment in the non-surgicalmedical treatment area such that healing is accelerated and a return toa more normal pre-treatment condition is stimulated.

In various embodiments, a method of treating humans with anantifibrinolytic agent prior to a non-surgical medical treatment can beutilized in order to reduce post-treatment inflammation, bruising,and/or swelling. In certain embodiments, the method includes utilizing apharmaceutical composition containing an antifibrinolytic agent. In someembodiments, the pharmaceutical composition is a solution having aconcentration of up to 30% (w/v) of an antifibrinolytic agent, and can,optionally be in a pharmaceutically acceptable carrier in which thesolution can be adaptable for use on human skin. In various embodiments,the concentration can be up to 60% (w/v) of the antifibrinolytic agent.In some embodiments, the antifibrinolytic agent is in a concentration ofabout 20% (w/v). In particular embodiments, the antifibrinolytic agentis tranexamic acid in a concentration of about 20% (w/v).

In certain embodiments, the pharmaceutical composition antifibrinolyticagent is tranexamic acid, which can also, optionally be in apharmaceutically acceptable carrier that can adapt to human skin. Inother embodiments, the antifibrinolytic agent can be administered priorto the injection of a non-surgical medical treatment in order to reducepost-injection inflammation, bruising and/or swelling. In otherembodiments, the agent can be applied and composed in such a manner thatit does not negatively impact subsequent treatments.

In various embodiments, a method of treating humans with anantifibrinolytic agent prior to, during and/or post non-surgical medicaltreatment can be utilized in order to reduce inflammation, bruisingand/or swelling. In certain embodiments, a non-surgical medicaltreatment can be enhanced by the antifibrinolytic agent therebyproviding the benefit of extending the duration/function of dermalfillers and toxins. In various embodiments, a solution containing anantifibrinolytic agent can be utilized in order to reduce inflammation,bruising and/or swelling and can have a limited application time, forexample, 3 minutes. In other embodiments, the solution can have anapplication time ranging from approximately 2 to 5 minutes. In certainembodiments, the solution application time can range from 3 to 10minutes.

Dermal fillers, for example, JUVEDERM® and RESTYLANE®, used incosmetic/dermatologic treatments, typically contain hyaluronic acid.Dermal fillers are typically injected into the skin (e.g., mid to deepdermis in the cheeks, around the eyes or the lip/perioral area) and actto provide volume to the injected area, leaving a more youthfulappearance. Dermal filler treatment effects usually last 6 to 12 months.Toxins used in cosmetic/dermatologic treatments typically containneurotoxins, for example, BOTOX®. These toxins are typically injectedinto the skin (e.g., the glabella area) and act to relax the muscles ofthe face thereby reducing lines and wrinkles around the injected area,and the effects usually last 3 to 6 months.

It is contemplated that by inhibiting the conversion of plasminogen toplasmin, which breaks down a variety of substances, such as fibrin andcollagen, antifibrinolytic agents could prolong the time it takes forthe body to break down injected substances, for example, hyaluronic acidand/or various neurotoxins. By prolonging the time it takes for the bodyto break down injected substances, the present invention seeks toimprove the performance of the injected agent. In certain embodiments,antifibrinolytic agents such as tranexamic acid can be utilized prior toa non-surgical medical treatment, for example, a dermal fillerinjection, to reduce swelling and bruising that typically result fromthe treatment. In other embodiments, antifibrinolytic agents such astranexamic acid can be utilized post-treatment (e.g., after a dermalfiller injection) to reduce bruising in the treated area.

To further investigate the role of antifibrinolytic agents innon-surgical medical treatments, high-performance liquid chromatography(HPLC) analysis was performed on tranexamic acid and a carriercontaining hyaluronic acid (i.e. hyaluronan), which is a commonsubstance used to create a gel-like consistency in products appliedtopically to the skin and could be a possible carrier for anantifibrinolytic agent in non-surgical medical treatments, as well as ona common hyaluronic acid dermal filler, which contain cross-linkedhyaluronic acid polymers to give them greater longevity, to see whetherthere was a change in either form of hyaluronic acid when mixed withtranexamic acid. First a skin care product from ERACLEA® Skin Carecontaining 1% (w/v) hyaluronic acid polymer and preservatives wastested. After the HPLC profile of tranexamic acid and the ERACLEA®product were established, an amount of tranexamic acid was added to theERACLEA® product giving a 3% (w/v) concentration of tranexamic acid. Theanalysis was carried out with fresh sample preparations being mixed andimmediately injected into the HPLC system for analysis as well as samplepreparations that were mixed and allowed to stand for a 20 minute timeperiod prior to injection.

Interaction studies between tranexamic acid and hyaluronic acid polymerwere further conducted via HPLC on samples of the same ERACLEA® productto which concentrations of 0.5% (w/v) tranexamic acid and 3% (w/v)tranexamic acid had been added several weeks before. HPLC analysis wasfurther conducted by adding 3% (w/v) tranexamic acid to a hyaluronicacid dermal filler and, more particularly, JUVEDERM® filler. Similar tothe above-mentioned study, the JUVEDERM® analysis was carried out withfresh sample preparations being immediately injected for analysis aswell as sample preparations that were allowed to stand for a 20 minutetime period prior to injection. None of the analyses showed anyinteraction between tranexamic acid and either form of hyaluronic acidpolymer.

Further, HPLC analysis was carried out on hyaluronic acid filler,specifically JUVEDERM®, when mixed with human plasmin and withphysiological saline. The objectives of these analyses were todemonstrate the degradation of hyaluronic acid filler, and inparticular, the complete degradation of hyaluronic acid filler in asample after treatment with human plasmin, with no effect when mixedwith physiological saline. The foregoing analyses will now be describedwith respect to each analysis in further detail below.

HPLC Method Development for Tranexamic Acid

The sample preparation was prepared as follows: 100 μL of tranexamicacid (Source: AUROMEDICS®, concentration 100 mg/mL sterile solution) wastaken out from vial via syringe and diluted to 1000 μL volume by addingan aqueous solution of 60:40 ratio, by volume, distilledwater/acetonitrile. This stock solution was used multiple times todevelop HPLC methods for comparison with hyaluronic acid polymer, fillerand human plasmin. Table 1, shown below, represents ultraviolet (UV)results for tranexamic acid undergoing HPLC with a flow rate of 1mL/min, a sample concentration of 10 mg/mL, and an injection volume of10 μL, a wave length of 205 nm and a solvent system of 40:60 ratio, byvolume, acetonitrile/distilled water. As can be seen below, theretention time is 2.280 min for tranexamic acid.

TABLE 1 UV Results Retention Time Area Area % Height Height % 2.28031220907 100.00 4825881 100.00 Totals 31220907 100.00 4825881 100.00

HPLC Method Development for Hyaluronic Acid Polymer

The sample preparation was prepared as follows: 10 mg of hyaluronic acidpolymer (Source: ERACLEA®, pure hydration) was weighed in 2.5 mL of autosampler vial and diluted to 1000 μL volume by adding an aqueous solutionof 60:40 ratio, by volume, distilled water/acetonitrile and used as astandard stock solution. Table 2, shown below, represents UV results forhyaluronic acid polymers undergoing HPLC with a flow rate of 1 mL/min, asample concentration of 10 mg/mL, and an injection volume of 10 μL, awave length of 205 nm and a solvent system of 40:60 ratio, by volume,acetonitrile/distilled water. As can be seen below, the retention timeis 7.467 min for hyaluronic acid polymer.

TABLE 2 UV Results Retention Time Area Area % Height Height % 7.4676537978 100.00 795794 100.00 Totals 6537978 100.00 795794 100.00

Retention time differences calculated between tranexamic acid andhyaluronic acid polymer was 5.187 min utilizing the tranexamic acidretention time of 2.280 min and the hyaluronic acid polymer retentiontime of 7.467 min.

HPCL Study to Detect Any Binding Interaction of Tranexamic Acid withHyaluronic Acid Polymer

Table 3, shown below, represents the UV results for freshly prepared 3%(w/v) tranexamic acid in hyaluronic acid polymer immediately injected toundergo HPLC with a flow rate of 1 mL/min, a sample concentration of 10mg/mL, and an injection volume of 10 μL, a wave length of 205 nm and asolvent system of 40:60 ratio, by volume, acetonitrile/distilled water.As can be seen below, the retention times are 2.217 min and 7.577 minfor tranexamic acid and hyaluronic acid polymer, respectively.

TABLE 3 UV Results Retention Time Area Area % Height Height % 2.2171727195 19.92 190499 18.53 7.577 6942792 80.08 837835 81.47 Totals8669987 100.00 1028334 100.00

Table 4, shown below, represents the UV results for freshly prepared 3%(w/v) tranexamic acid in hyaluronic acid polymer that was allowed tostand for 20 min before being injected to undergo HPLC with a flow rateof 1 mL/min, a sample concentration of 10 mg/mL, and an injection volumeof 10 μL, a wave length of 205 nm and a solvent system of 40:60 ratio,by volume, acetonitrile/distilled water. As can be seen below, theretention times are 2.217 min and 7.577 min for tranexamic acid andhyaluronic acid polymer, respectively.

TABLE 4 UV Results Retention Time Area Area % Height Height % 2.2171727195 19.92 190499 18.53 7.577 6942792 80.08 837835 81.47 Totals8669987 100.00 1028334 100.00

Based on the data collected from the tranexamic acid in hyaluronic acidpolymer sample immediately injected to undergo HPLC and the sample thatwas allowed to stand for 20 minutes before being injected to undergoHPLC, there is no interaction between tranexamic acid with hyaluronicacid polymer over a 20 minute time period. To further illustrate that nointeractions between tranexamic acid with hyaluronic acid polymer exist,further samples and varying concentrations underwent HPLC analysis.

Table 5, shown below, represents UV results for 3% (w/v) tranexamic acidin a solution containing 1% (w/v) hyaluronic acid polymer, supplied byHylaco, LLC., several weeks prior to undergoing HPLC analysis. The HPLCwas conducted with a flow rate of 1 mL/min, a sample concentration of 10mg/mL, and an injection volume of 10 μL, a wave length of 205 nm and asolvent system of 40:60 ratio, by volume, acetonitrile/distilled water.As can be seen below, the retention times are 2.210 min and 7.520 minfor tranexamic acid and hyaluronic acid polymer, respectively.Similarly, the data shown below suggests there is no interaction betweentranexamic acid and this hyaluronic acid polymer when mixed in solution.

TABLE 5 UV Results Retention Time Area Area % Height Height % 2.2101551176 20.08 183071 19.62 7.520 6175358 79.92 750126 80.38 Totals7726534 100.00 933197 100.00

Table 6, shown below, represents UV results for 0.5% (w/v) tranexamicacid in a solution containing 1% (w/v) hyaluronic acid polymer, suppliedby Hylaco, LLC., several weeks prior to undergoing HPLC analysis. TheHPLC was conducted with a flow rate of 1 mL/min, a sample concentrationof 12.0 mg/mL, and an injection volume of 10 μL, a wave length of 205 nmand a solvent system of 60:40 ratio, by volume, acetonitrile/distilledwater. As can be seen below, the retention times are 2.197 min and 7.593min for tranexamic acid and hyaluronic acid polymer, respectively.

TABLE 6 UV Results Retention Time Area Area % Height Height % 2.1971222461 11.87 197696 15.40 7.593 9077617 88.13 1085696 84.60 Totals10300078 100.00 1283392 100.00

Table 7, shown below, represents UV results for 0.5% (w/v) tranexamicacid in hyaluronic acid polymer (scratch sample), supplied by Hylaco,LLC., several weeks prior to undergoing HPLC analysis. The HPLC wasconducted with a flow rate of 1 mL/min, a sample concentration of 11.6mg/mL, and an injection volume of 10 μL, a wave length of 205 nm and asolvent system of 40:60 ratio, by volume, acetonitrile/distilled water.As can be seen below, the retention times are 2.170 min and 7.497 minfor tranexamic acid and hyaluronic acid polymer, respectively.

TABLE 7 UV Results Retention Time Area Area % Height Height % 2.1701829993 13.60 250210 15.06 7.497 11626123 86.40 1411177 84.94 Totals13456116 100.00 1661387 100.00

The above-presented data indicates that tranexamic acid does not appearto interact with this form of hyaluronic acid polymer in an aqueoussolution with a gel-like consistency for easy topical application. Thustranexamic acid is shown to be compatible with carriers used in topicalpreparations. Further analysis was made to determine whether tranexamicacid would interact with hyaluronic acid in a cross-linked form used fordermal fillers, specifically one of a JUVEDERM® family filler, and couldthus be suitable for use before and after non-surgical medicaltreatments to reduce inflammation, bruising and/or swelling when thenon-surgical medical treatment utilizes hyaluronic acid dermal fillers.

HPLC Method Development for Hyaluronic Acid Filler

The sample preparation was prepared as follows: 13 mg of filler (Source:JUVEDERM® Vollere XC) was weighed in a 2.5 mL vial and diluted to 1000μL volume by adding an aqueous solution of 60:40 ratio, by volume,distilled water/acetonitrile. Table 8, shown below, represents UVresults for JUVEDERM® Vollere XC undergoing HPLC with a flow rate of 1mL/min, a sample concentration of 13 mg/mL (from syringe), and aninjection volume of 10 μL, a wave length of 205 nm and a solvent systemof 40:60 ratio, by volume, acetonitrile/distilled water. As can be seenbelow, the retention times are 2.167 min, 3.420 min and 9.953 min forthe filler, with the largest area represented by the 3.420 min retentiontime.

TABLE 8 UV Results Retention Time Area Area % Height Height % 2.167993958 13.62 81482 10.56 3.420 6304189 86.38 690337 89.43 9.953 117 0.0088 0.01 Totals 7298264 100.00 771907 100.00

Table 9, shown below, represents the UV results for freshly prepared 3%(w/v) tranexamic acid in JUVEDERM® filler immediately injected toundergo HPLC with a flow rate of 1 mL/min, a sample concentration of 10mg/mL, and an injection volume of 10 μL, a wave length of 205 nm and asolvent system of 40:60 ratio, by volume, acetonitrile/distilled water.As can be seen below, the retention times are 2.327 min and 3.143 minfor tranexamic acid and JUVEDERM® filler, respectively.

TABLE 9 UV Results Retention Time Area Area % Height Height % 2.3271818080 25.45 208612 21.59 3.143 5326600 74.55 757587 78.41 Totals7144680 100.00 966199 100.00

Table 10, shown below, represents the UV results for freshly prepared 3%(w/v) tranexamic acid in JUVEDERM® filler that was allowed to stand for20 min before being injected to undergo HPLC with a flow rate of 1mL/min, a sample concentration of 10 mg/mL, and an injection volume of10 μL, a wave length of 205 nm and a solvent system of 40:60 ratio, byvolume, acetonitrile/distilled water. As can be seen below, theretention times are 2.327 min and 3.143 min for tranexamic acid andJUVEDERM® filler, respectively.

TABLE 10 UV Results Retention Time Area Area % Height Height % 2.3271818080 25.45 208612 21.59 3.143 5326600 74.55 757587 78.41 Totals7144680 100.00 966199 100.00

Based on the data collected from the tranexamic acid in JUVEDERM® fillerimmediately injected to undergo HPLC and the sample that was allowed tostand for 20 minutes before being injected to undergo HPLC, there is nointeraction between tranexamic acid with the filler over a 20 minutetime period. Data suggests that if there is any interaction betweentranexamic acid and dermal filler material, it would be demonstratedduring their direct contact over 20 minutes, especially since there wasno interaction between tranexamic acid and hyaluronic acid in the gelsolution when in contact for several weeks.

To investigate the possible degradation of the hyaluronic acid fillercaused by human plasmin, hyaluronic acid filler was analyzed using HPLCwith the hyaluronic acid filler in contact with human plasmin, as wellas bathed in physiological saline.

HPLC Study to Measure the Degradation of Hyaluronic Acid Filler inContact with Human Plasmin

The sample preparation was prepared as follows: 13 mg of filler (Source:JUVEDERM® Vollere XC) was weighed in a 2.5 mL vial and diluted to 1000μL volume by adding an aqueous solution of 60:40 ratio, by volume,distilled water/acetonitrile. From this stock solution 100 μL was takenout and mixed with 100 μL of 5 U (0.5 mL) human plasmin (Source: SigmaAldrich, Lot #17148421) and slowly shaken for 15 min, filtered andinjected into the HPLC system. Table 11, shown below, represents UVresults for the sample undergoing HPLC with a flow rate of 1 mL/min, asample concentration of 13 mg/mL, and an injection volume of 10 μL, awave length of 205 nm and a solvent system of 40:60 ratio, by volume,acetonitrile/distilled water. The data below suggests that there is acomplete degradation of filler hyaluronic acid polymer after thetreatment of human plasmin, as there is no retention peak at 3.14 min(i.e., the filler peak).

TABLE 11 UV Results Retention Time Area Area % Height Height % 3.00320274447 55.69 662692 25.27 3.900 16133924 44.31 1960052 74.73 Totals36408371 100.00 2622744 100.00

Retention times of 3.003 min and 3.900 min are shown above, with thenotable absence of a retention peak at 3.14 min. Table 11 demonstratesthe complete degradation of filler hyaluronic acid polymer aftertreatment of human plasmin due to the absence of a retention peak at3.14 min, which would appear if the filler had been present.

A comparison of the filler data with the human plasmin-treated fillerdata indicates that the retention peak at 3.14 is absent in the humanplasmin-treated filler, while the retention peak is clearly observablein the filler. The data demonstrates the complete degradation of fillerhyaluronic acid polymer after treatment of human plasmin.

HPLC Study to Measure the Degradation of Hyaluronic Acid Filler afterBathed in Physiological Saline

The sample preparation was prepared as follows: 10 mg of filler (Source:JUVEDERM® Vollere XC) was weighed in a 2.5 mL vial and diluted to 1000μL volume by adding an aqueous solution of 60:40 ratio, by volume,distilled water/acetonitrile. From this stock solution 100 μL was takenout and mixed with 100 μL of physiological saline (Source: Hospira,Inc., Lot 64-154-DK) and slowly shaken for 15 min, filtered and injectedinto the HPLC system. Table 12, shown below, represents UV results forthe sample undergoing HPLC with a flow rate of 1 mL/min, a sampleconcentration of 10 mg/mL, and an injection volume of 10 μL, a wavelength of 205 nm and a solvent system of 40:60 ratio, by volume,acetonitrile/distilled water. As can be seen below, the retention timesare 2.353 min and 3.120 min.

TABLE 12 UV Results Retention Time Area Area % Height Height % 2.3535281424 54.39 714706 56.82 3.120 4428834 45.61 543064 43.18 Totals9710258 100.00 1257770 100.00

Overview of Results

As shown above in the preceding discussion, tranexamic acid does notappear to interact with hyaluronic acid, whether in a gel form or incross-linked form for use as a dermal filler, and could thus be suitablefor use before and after non-surgical medical treatments to reduceinflammation, bruising and/or swelling when the non-surgical medicaltreatment involves a hyaluronic acid-based dermal filler.

As shown above, the mixture of tranexamic acid and JUVEDERM® was allowedto stand for 20 minutes, which is indication that there is nointeraction between tranexamic acid and dermal filler material. Inaddition, there was no interaction between tranexamic acid and thehyaluronic acid in the ERACLEA® product when left in contact for severalweeks, and cross-linked hyaluronic acid in dermal fillers is generallymuch more robust than hyaluronic acid that has not been cross-linked. Ina dermal filler procedure, tranexamic acid will generally be in contactwith the hyaluronic acid material in the skin no more than about 18hours before the tranexamic acid is metabolized by the body.

Moreover, the data indicates usage of tranexamic acid may in factincrease the duration and efficacy of filler treatments, in vivo, asfiller hyaluronic acid polymer is totally degraded by human plasmin, andantifibrinolytic agents, such as tranexamic acid, inhibit the conversionof plasminogen to plasmin.

Additionally, as will be discussed below, clinical studies indicate thatthe addition of tranexamic acid to non-surgical treatments have provento reduce bruising and swelling, as compared to clinical studiesconducted in the absence of antifibrinolytic agents, such as tranexamicacid.

Clinical Studies

A randomized, controlled, clinical evaluation of JUVEDERM® Ultra XC inthe nasolabial folds was conducted over a two week time period(conducted by Allergan) and common treatment site responses, by severityand duration, were presented. The most common injection site responsesfor JUVEDERM® Ultra XC were redness, swelling, tenderness, firmness,lumps/bumps, discoloration and bruising. According to the study,overall, 86% of subjects reported swelling and 59% of subjects reportedbruising.

In non-surgical use conducted over approximately a 1 year period, 318patients were subjected to a solution with a 3% (w/v) concentration oftranexamic acid before and after injection of hyaluronic acid dermalfiller. Less than 1% of patients reported instances of bruising andswelling, an exponential and unexpected decline when compared tohyaluronic filler treatments without the use of tranexamic acid. Threepatients of the 318 reported instances of bruising or swelling.

As shown above in clinical use, tranexamic acid plays a vital role inthe suppression of bruising and swelling. This can be attributed to theactivity of antifibrinolytic agents at the injection-site ofnon-surgical medical treatments. Further, based on the above-presentedlaboratory data, antifibrinolytic agents can play a vital role inslowing down the breakdown of injected hyaluronic acid dermal filler, byinhibiting the conversion of plasminogen to plasmin.

Bruising Studies

Although use of a solution having a 3% (w/v) concentration of tranexamicacid used with non-surgical medical treatments (e.g. dermal fillerprocedures) showed positive results in that it indicated a very lowpercentage of patients experiencing bruising based on immediateobservation, a study of additional concentrations of tranexamic acidused with non-surgical medical treatments was conducted. Specifically,patients undergoing dermal filler procedures were recorded for up to 48hours after the dermal filler procedures to study varying concentrationeffects of tranexamic acid usage with the non-surgical medicalprocedures.

The study provided herein utilized concentrations of tranexamic acidranging from about 3% (w/v) to about 20% (w/v). Specifically, tranexamicacid concentrations of 3% (w/v), 5% (w/v), 10% (w/v), and 20% (w/v) wereapplied before and after dermal filler procedures by swabbing the areasof skin to be treated with gauze soaked with a tranexamic acid solution,such as those disclosed herein, as well as a 3% (w/v) tranexamic acidsolution applied before and after the dermal filler procedure, and bythe patient at home for two days. Surprisingly, with the 48-hourobservation time, a three-fold improvement in bruising incidence wasobserved for the 20% (w/v) tranexamic acid solution. Approximately 45%of patients experienced no bruising, compared to only about 15% for theother series of patients.

For the 20% (w/v) tranexamic acid solution, data was also gathered onthe severity of bruising (none, mild, moderate, and severe) and thencompared to the severity of bruising reported in the labeling for two ofthe most common dermal filler products, JUVEDERM VOLLURE™ XC andJUVEDERM VOLBELLA® XC, when administered without any antifibrinolyticagent. The comparison indicated that about 28% more patients experiencedno bruising when a tranexamic acid solution was used. In addition, whenbruising occurred, no patients bruised severely when the tranexamic acidsolution was used, compared to almost 20% who bruised severely without atranexamic acid solution, indicating a 100% improvement. Additionally,67% of patients only bruised mildly with the tranexamic acid solutioncompared to 37% bruising mildly without a tranexamic acid solution,indicating an 80% improvement. Mild to no bruising combined constituted82% of patients receiving the tranexamic acid solution, compared to 52%not receiving a tranexamic acid solution, indicating a 58% improvement.

In various embodiments, the antifibrinolytic agent can be aprotinin,tranexamic acid, epsilon-aminocaproic acid (EACA), a Kunitz domain (KD1)inhibitor, AZD 6564 and analogues or derivatives of the same. In variousembodiments, the Kunitz domain inhibitor can be a Kunitz-type inhibitorsimilar to KD1.

In certain embodiments, EACA can be utilized as the antifibrinolyticagent in a solution up to 60% (w/v) EACA. In some embodiments, theconcentration of EACA can range from about 7% (w/v) to about 60% (w/v).

In other embodiments, tranexamic acid can be utilized as theantifibrinolytic agent in a solution up to 30% (w/v) tranexamic acid. Invarious embodiments, the concentration of tranexamic acid can range fromabout 0.7% (w/v) to about 30% (w/v). In some embodiments, the tranexamicacid is about 3% (w/v). In some embodiments, the tranexamic acid isabout 5% (w/v). In some embodiments, the tranexamic acid is about 10%(w/v). In some embodiments, the tranexamic acid is about 15% (w/v). Insome embodiments, the tranexamic acid is about 20% (w/v). In someembodiments, the tranexamic acid is about 25% (w/v). In someembodiments, the tranexamic acid is about 30% (w/v).

In further embodiments, aprotinin can be utilized as theantifibrinolytic agent in a solution of at least 0.1% (w/v) aprotinin.

In still further embodiments, KD1 can be utilized as theantifibrinolytic agent in a solution of at least 0.1% (w/v) KD1.

In certain embodiments, AZD 6564 can be utilized as the antifibrinolyticagent in a solution of up to 15% (w/v). In further embodiments, theconcentration of AZD 6564 can range from about 0.35% (w/v) to about 15%(w/v).

In some embodiments, the antifibrinolytic agent can include, withoutlimitation, tranexamic acid, aprotinin, epsilon-aminocaproic acid(EACA), Kunitz domain (KD1) inhibitor, AZD 6564 analogs, derivatives, ormimetics.

In further embodiments, the present disclosure relates to a kit having acarrier and an antifibrinolytic agent packaged separately so as to beassembled on-site. In some embodiments, the kit includes a carrier andan antifibrinolytic agent. In some embodiments, the carrier and theantifibrinolytic agent are each individually packaged separately insterile form. In some embodiments, the carrier can include, withoutlimitation, a gel, a lotion, an ointment, a solution, or a cream. Insome embodiments, a combination of the carrier and the antifibrinolyticagent produces at least one of a gel, a lotion, an ointment, a solution,and a cream having a concentration of up to 60% (w/v) of theantifibrinolytic agent in the combination. In some embodiments, theantifibrinolytic agent is tranexamic acid and the concentration of thecombination is up to 30% (w/v) tranexamic acid. In some embodiments, theantifibrinolytic agent is tranexamic acid and the concentration of thecombination is about 20% (w/v) tranexamic acid. In some embodiments, thekit further includes at least one of a towellette or gauze forapplication of a combination of the carrier and the antifibrinolyticagent. In some embodiments, the carrier includes, but is not limited to,at least one of an inactive ingredient, a preservative, a gel, a lotion,an ointment, a solution, a cream, hyaluronic acid, a cross-linkedhyaluronic acid polymer, a dermal filler, a neurotoxin, andhydroxyethylcellulose.

Although various embodiments of the methods and compositions of thepresent disclosure have been illustrated in the accompanying tables anddrawings, and described in the foregoing Specification, it will beunderstood that the invention is not limited to the embodimentsdisclosed, but is capable of numerous rearrangements, modifications, andsubstitutions without departing from the spirit and scope of theinvention as set forth herein. It is intended that the Specification andexamples be considered as illustrative only.

What is claimed is:
 1. A method to enhance a non-surgical medicaltreatment, the method comprising: applying a composition comprising anantifibrinolytic agent to an area of skin for non-surgical medicaltreatment, wherein the applying is at least one of before, during, andafter the non-surgical medical treatment; beginning the non-surgicalmedical treatment to the area of skin; and continuing the non-surgicalmedical treatment until the non-surgical medical treatment is completed.2. The method of claim 1, wherein the antifibrinolytic agent is part ofa solution.
 3. The method of claim 2, wherein the solution has aconcentration of up to 60% (w/v) of the antifibrinolytic agent.
 4. Themethod of claim 2, wherein the antifibrinolytic agent is selected fromthe group consisting of tranexamic acid, aprotinin, epsilon-aminocaproicacid (EACA), Kunitz domain (KD1) inhibitor, AZD 6564, or an analog,derivative, or mimetic thereof.
 5. The method of claim 4, wherein theantifibrinolytic agent is tranexamic acid with a concentration of up to30% (w/v).
 6. The method of claim 4, wherein the antifibrinolytic agentis tranexamic acid with a concentration of about 20% (w/v).
 7. Themethod of claim 4, wherein the antifibrinolytic agent is aprotinin witha concentration of at least 0.1% (w/v).
 8. The method of claim 4,wherein the antifibrinolytic agent is EACA with a concentration of up to60% (w/v).
 9. The method of claim 4, wherein the antifibrinolytic agentis KD1 with a concentration of at least 0.1% (w/v).
 10. The method ofclaim 4, wherein the antifibrinolytic agent is AZD 6564 with aconcentration of up to 15% (w/v).
 11. The method of claim 2, wherein thecomposition is applied as part of a pharmaceutically acceptable carrierwhich adapts the solution to human skin.
 12. The method of claim 11,wherein the pharmaceutically acceptable carrier is at least one of agel, a lotion, and a cream.
 13. The method of claim 1, wherein thenon-surgical medical treatment comprises an injection or applicationprocedure selected from the group consisting of a cosmetic procedure, adermatologic procedure, or combinations thereof.
 14. The method of claim13, comprising: combining the composition with a treatment materialprior to beginning the non-surgical medical treatment to form a combinedmaterial; and injecting or applying the combined material to the area ofskin being treated.
 15. The method of claim 1, wherein the applying thecomposition minimizes at least one of swelling, inflammation, andbruising.
 16. The method of claim 1, wherein the composition isdelivered systemically.
 17. The method of claim 1, wherein theantifibrinolytic agent extends at least one of duration and function ofthe non-surgical medical treatment.
 18. The method of claim 1, whereinthe non-surgical medical treatment is an injection of at least one of adermal filler and a neurotoxin.
 19. The method of claim 1, wherein thecomposition comprises at least one of an inactive ingredient, apreservative, a gel, hyaluronic acid, a cross-linked hyaluronic acidpolymer, a dermal filler, a neurotoxin, and hydroxyethylcellulose. 20.The method of claim 1, wherein the applying utilizes at least one ofgauze and a towelette pre-soaked with the composition.
 21. A method toenhance a non-surgical medical treatment, the method comprising:applying a composition comprising an antifibrinolytic agent to an areaof skin for non-surgical medical treatment, wherein the applying is atleast one of before, during, and after the non-surgical medicaltreatment, and wherein the antifibrinolytic agent comprises tranexamicacid in an amount of about 20% (w/v); beginning the non-surgical medicaltreatment to the area of skin; continuing the non-surgical medicaltreatment until the non-surgical medical treatment is completed; andminimizing, by the antifibrinolytic agent, bruising caused by thenon-surgical medical treatment.
 22. The method of claim 21, wherein theantifibrinolytic agent is part of a solution.
 23. The method of claim22, wherein the composition is applied as part of a pharmaceuticallyacceptable carrier which adapts the solution to human skin.
 24. Themethod of claim 23, wherein the pharmaceutically acceptable carrier isat least one of a gel, a lotion, and a cream.
 25. The method of claim21, comprising combining the composition with a treatment material priorto beginning the non-surgical medical treatment to form a combinedmaterial, and wherein the beginning the non-surgical medical treatmentcomprises injecting the combined material to the area of skin beingtreated.
 26. The method of claim 25, wherein the treatment materialcomprises at least one of hyaluronic acid, a cross-linked hyaluronicacid polymer, a dermal filler, and a neurotoxin.
 27. The method of claim21, comprising minimizing, by the antifibrinolytic agent, at least oneof swelling and inflammation.
 28. The method of claim 21, wherein thecomposition is delivered systemically.
 29. The method of claim 21,comprising extending, by the antifibrinolytic agent, at least one ofduration and function of the non-surgical medical treatment.
 30. Themethod of claim 21, wherein the non-surgical medical treatment comprisesan injection or application procedure selected from the group consistingof a cosmetic procedure, a dermatologic procedure, or combinationsthereof.
 31. The method of claim 21, wherein the non-surgical medicaltreatment is an injection of at least one of a dermal filler and aneurotoxin.
 32. The method of claim 21, wherein the compositioncomprises at least one of an inactive ingredient, a preservative, a gel,hyaluronic acid, a cross-linked hyaluronic acid polymer, a dermalfiller, a neurotoxin, and hydroxyethylcellulose.
 33. The method of claim21, wherein the applying utilizes at least one of gauze and a towelettepre-soaked with the composition.
 34. A composition to enhance anon-surgical medical treatment, the composition comprising anantifibrinolytic agent.
 35. The composition of claim 34, wherein theantifibrinolytic agent is part of a solution.
 36. The composition ofclaim 35, wherein the composition is applied topically as part of apharmaceutically acceptable carrier which adapts the solution to humanskin, and wherein the pharmaceutically acceptable carrier is at leastone of a gel, a lotion, and a cream.
 37. The composition of claim 35,wherein the solution has a concentration of up to 60% (w/v) of theantifibrinolytic agent.
 38. The composition of claim 34, wherein theantifibrinolytic agent is selected from the group consisting oftranexamic acid, aprotinin, epsilon-aminocaproic acid (EACA), Kunitzdomain (KD1) inhibitor, AZD 6564, or an analog, derivative, or mimeticthereof.
 39. The composition of claim 38, wherein the antifibrinolyticagent is tranexamic acid with a concentration of up to 30% (w/v). 40.The composition of claim 38, wherein the antifibrinolytic agent istranexamic acid with a concentration of about 20% (w/v).
 41. Thecomposition of claim 34, comprising at least one of an inactiveingredient, a preservative, a gel, hyaluronic acid, a cross-linkedhyaluronic acid polymer, a dermal filler, a neurotoxin, andhydroxyethylcellulose.
 42. The composition of claim 34, wherein thecomposition is used in conjunction with the non-surgical medicaltreatment, and wherein the non-surgical medical treatment comprises aninjection or application procedure selected from the group consisting ofa cosmetic procedure, a dermatologic procedure, or combinations thereof.43. The composition of claim 34, wherein application of the compositionminimizes at least one of swelling, inflammation, and bruising.
 44. Thecomposition of claim 34, wherein the composition is administereddirectly on or into human skin prior to, during, or after thenon-surgical medical treatment.
 45. The composition of claim 34, whereinthe composition is applied directly on human skin via at least one ofpre-soaked gauze and a pre-soaked towelette prior to, during, or afterthe non-surgical medical treatment.
 46. A kit comprising a carrier andan antifibrinolytic agent.
 47. The kit of claim 46, wherein the carrierand the antifibrinolytic agent are each individually packaged separatelyin sterile form.
 48. The kit of claim 46, wherein the carrier isselected from the group consisting of a gel, a lotion, an ointment, asolution, or a cream.
 49. The kit of claim 46, wherein a combination ofthe carrier and the antifibrinolytic agent produces at least one of agel, a lotion, an ointment, a solution, and a cream having aconcentration of up to 60% (w/v) of the antifibrinolytic agent in thecombination.
 50. The kit of claim 49, wherein the antifibrinolytic agentis tranexamic acid, and wherein the concentration of the combination isup to 30% (w/v) tranexamic acid.
 51. The kit of claim 49, wherein theantifibrinolytic agent is tranexamic acid, and wherein the concentrationof the combination is about 20% (w/v) tranexamic acid.
 52. The kit ofclaim 46, comprising at least one of a towellette or gauze forapplication of a combination of the carrier and the antifibrinolyticagent.
 53. The kit of claim 46, wherein the carrier comprises at leastone of an inactive ingredient, a preservative, a gel, a lotion, anointment, a solution, a cream, hyaluronic acid, a cross-linkedhyaluronic acid polymer, a dermal filler, a neurotoxin, andhydroxyethylcellulose.